Dental treatment can, in rare cases, trigger anorexia nervosa in those susceptible to the illness, a psychiatrist has claimed. Tony Jaffa, of the Phoenix Adolescent Eating Disorders Centre in Cambridge, reports that out of approximately 100 case referrals over the last two years, he has seen three teenagers for whom the trigger for anorexia appeared to be dental treatment.

A 12-year-old lost weight for nine months following a visit to the dentist at which she was advised to stop eating sweets between meals. “She did so but then progressed to not snacking between meals and reducing her meal portions,” Jaffa said.

A 16-year-old had experienced two years of eating problems since having a brace fitted to re-align her teeth. Her mouth was made sore by the brace, and her dentist also advised her to avoid sweet foods. “She probably never resumed a normal diet from this point…”, Jaffa said. “She reported knowing that she was underweight and yet continuing to feel ‘big’.”

Finally, Jaffa described the case of a 14-year-old who started eating soups and soft food after having a brace fitted. A friend told her she might lose weight when she had the brace fitted and the episode sparked a prolonged interest in weighing herself and a desire to become thinner. “She complained of feeling fat. She used the discomfort of the braces as an excuse not to eat,” Jaffa said.

All three cases had also experienced other stressors – for example, exams, the death of a pet, or low self-esteem – typical adolescent experiences which Jaffa said may also have played a contributory role.

The media and society’s obsession with the thin ideal is normally blamed for triggering anorexia in those at risk of the illness. But Jaffa said these cases showed “the professional community should be…more attentive to the range of factors which can cause weight loss and which therefore may be precipitants of anorexia nervosa in susceptible individuals.”

If the profile of this issue were raised, dentists might be encouraged to be more careful about when and how they give out dietary advice, Jaffa concluded.___________________________________

Editor’s note: remember, although these case reports may be suggestive of an association between dental treatment and anorexia in some people, such a link has not been demonstrated experimentally or epidemiologically.